[Federal Register Volume 74, Number 208 (Thursday, October 29, 2009)]
[Notices]
[Page 55825]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-26029]


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DEPARTMENT OF DEFENSE

Office of the Secretary

[Docket ID: DoD-2009-HA-0154]


Proposed Collection; Comment Request

AGENCY: Office of the Assistant Secretary of Defense for Health 
Affairs, DoD.

ACTION: Notice.

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SUMMARY: In compliance with section 3506(c)(2)(A) of the Paperwork 
Reduction Act of 1995, the Office of the Assistant Secretary of Defense 
for Health Affairs announces the proposed extension of a public 
information collection and seeks public comment on the provisions 
thereof. Comments are invited on: whether the proposed collection of 
information is necessary for the proper performance of the functions of 
the agency, including whether the information shall have practical 
utility; the accuracy of the agency's estimate of the burden of the 
proposed information collection; ways to enhance the quality, utility, 
and clarity of the information to be collected; and ways to minimize 
the burden of the information collection on respondents, including 
through the use of automated collection techniques or other forms of 
information technology.

DATES: Consideration will be given to all comments received by December 
28, 2009.

ADDRESSES: You may submit comments, identified by docket number and 
title, by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Federal Docket Management System Office, 1160 
Defense Pentagon, Washington, DC 20301-1160.
    Instructions: All submissions received must include the agency 
name, docket number and title for this Federal Register document. The 
general policy for comments and other submissions from members of the 
public is to make these submissions available for public viewing on the 
Internet at http://www.regulations.gov as they are received without 
change, including any personal identifiers or contact information.

FOR FURTHER INFORMATION CONTACT: To request more information on this 
proposed information collection or to obtain a copy of the proposal and 
associated collection instruments, please write to: TMA Uniform 
Business Office, OASD(HA)/TMA/Management Control & Financial Studies, 
5111 Leesburg Pike, Falls Church, Virginia 22041, Skyline 5, Suite 
407--ATTN: DeLisa E. Prater, Program Manager, at 703-681-3492 ext.6757 
(DSN 761).
    Title; Associated Form; and OMB Number: Third Party Collection 
Program/Medical Services Account/Other Health Insurance; DD FORM 2569; 
OMB Control Number 0704-0323.
    Needs and Uses: DoD implemented the Coordination of Benefits 
Program in FY87 based on authority of 10 U.S.C. 1095, enacted as 
section 2001 of Public Law 99-272, Consolidated Omnibus Budget 
Reconciliation Act of 1986 (COBRA), April 7, 1986, and Uniform Business 
Office (UBO) Manual 6010.15-M, Military Treatment Facility UBO Manual, 
April 1997. Under this program, DoD is required to collect from third-
party payers the cost of inpatient and outpatient services rendered to 
military retirees, all dependents, and others who have private health 
insurance. Part 220 of Title 32 of the Code of Federal Regulations, 
implements 10 U.S.C. 1095. Specifically, 32 CFR 220.2(d) states that 
the form must be available to third-party payers upon request. A third-
party payer may not request any other assignment of benefits form from 
the subscriber.
    Affected Public: Business or other for profit; Not-for-profit 
institutions.
    Annual Burden Hours: 175,370.
    Number of Respondents: 3,507,390.
    Responses per Respondent: 1.
    Average Burden per Response: 3 minutes.
    Frequency: Annually or On occasion (when insurance information 
changes).

SUPPLEMENTARY INFORMATION:

Summary of Information Collection

    The administration has placed increased emphasis upon recovery of 
health care expenses under Third Party Collection Program, as 
authorized by title 10, section 1095 and 1097b of the United States 
Code. Completion of this form, while increasing total burden hours, 
will aid in increasing revenues (O&M dollars), services and operating 
efficiency and effectiveness within the Military Health Services 
system. This information is collected either during the inpatient stay 
admission and/or discharge process or during the visit when a patient 
presents for an outpatient procedure.

    Dated: October 23, 2009.
Patricia L. Toppings,
OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. E9-26029 Filed 10-28-09; 8:45 am]
BILLING CODE 5001-06-P